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Hormonal contraception alters vaginal microbiota and cytokines in South African adolescents in a randomized trial

Journal Article · · Nature Communications
 [1];  [1];  [1];  [1];  [2];  [1];  [3];  [1];  [4];  [5];  [5];  [6];  [7];  [8];  [1];  [9];  [2];  [5];  [10];  [11]
  1. Univ. of Cape Town (South Africa). Inst. of Infectious Disease and Molecular Medicine
  2. Univ. of Cape Town (South Africa)
  3. Univ. of Cape Town (South Africa). Inst. of Infectious Disease and Molecular Medicine, and Desmond Tutu HIV Centre
  4. Fred Hutchinson Cancer Research Center, Seattle, WA (United States)
  5. Univ. of Cape Town (South Africa). Desmond Tutu HIV Centre
  6. Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)
  7. Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Univ. of California, Berkeley, CA (United States)
  8. National Institute for Communicable Diseases, Sandringham, Johannesburg (South Africa)
  9. Emory Univ., Atlanta, GA (United States)
  10. Univ. of Cape Town (South Africa). Inst. of Infectious Disease and Molecular Medicine; National Health Laboratory Service, CapeTown (South Africa)
  11. Univ. of Cape Town (South Africa). Inst. of Infectious Disease and Molecular Medicine; Seattle Children’s Research Institute, Seattle, WA (United States); Univ. of Washington, Seattle, WA (United States)
+ Show Author Affiliations

Young women in sub-Saharan Africa are disproportionally affected by HIV infection and unintended pregnancies. However, hormonal contraceptive (HC) use may influence HIV risk through changes in genital tract microbiota and inflammatory cytokines. To investigate this, 130 HIV negative adolescent females aged 15–19 years were enrolled into a substudy of UChoose, an open-label randomized crossover study (NCT02404038), comparing acceptability and contraceptive product preference as a proxy for HIV prevention delivery methods. Participants were randomized to injectable norethisterone enanthate (Net-En), combined oral contraceptives (COC) or etonorgesterol/ethinyl estradiol combined contraceptive vaginal ring (CCVR) for 16 weeks, then crossed over to another HC for 16 weeks. Cervicovaginal samples were collected at baseline, crossover and exit for characterization of the microbiota and measurement of cytokine levels; primary endpoints were cervical T cell activation, vaginal microbial diversity and cytokine concentrations. Adolescents randomized to COCs had lower vaginal microbial diversity and relative abundance of HIV risk-associated taxa compared to Net-En or CCVR. Cervicovaginal inflammatory cytokine concentrations were significantly higher in adolescents randomized to CCVR compared to COC and Net-En. This suggests that COC use may induce an optimal vaginal ecosystem by decreasing bacterial diversity and inflammatory taxa, while CCVR use is associated with genital inflammation.

Research Organization:
Lawrence Berkeley National Laboratory (LBNL), Berkeley, CA (United States)
Sponsoring Organization:
USDOE Office of Science (SC)
Grant/Contract Number:
AC02-05CH11231
OSTI ID:
1768055
Journal Information:
Nature Communications, Journal Name: Nature Communications Journal Issue: 1 Vol. 11; ISSN 2041-1723
Publisher:
Nature Publishing GroupCopyright Statement
Country of Publication:
United States
Language:
English

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